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ged. Once the steps of the technique are
followed, the rest of the procedure is indiffe-
rent to the conventional one, even allowing
in most cases for a good critical safety view.
However, the most important technical di-
sadvantage is perhaps the collision of the
forceps in the umbilical trocars. In expe-
rience, this can be avoided by positioning
the optic on as vertical an axis as possible
(taking advantage of being 30°) and not ge-
tting too close to the operative field when
the main surgeon is using the third trocar's
forceps; once the forceps have been secu-
red at a point where they do not need to be
mobilized, the cameraman can approach
without problems. Another way to avoid
this problem is the correct placement of the
trocars at the beginning of the surgery: wi-
thin the same umbilical incision, the further
apart the introduction orifices of both trocars
are and the more they are placed on a di-
fferent rotational axis (creating a kind of "X"
between them), the lower the probability of
inter-instrument collision.
For Garnica (13), the greatest advantage
provided by the TILC technique is regarding
the cosmetic result and postoperative pain.
The data from the present study reveal that
pain is significantly less when quantified at
24 hours’ post-surgery following the already
mentioned instrument. This may be related to
the reduction in the number of skin incisions
made in this procedure, unlike the conven-
tional method. Regarding the aesthetic out-
come, it is directly related to the reduction in
the number of scars on the abdominal wall,
since the TILC technique uses 2 trocars in a
single incision that corresponds to the umbi-
lical scar, almost imperceptible. The other im-
portant point to highlight is that this surgical
procedure is performed in a similar operative
time and with a similar complication rate to
the conventional technique, being statistica-
lly non-significant, so it is considered safe
and effective, without emphasizing that the-
re is no need to use different instruments or
have a specific learning curve, so the costs
of the surgery are practically identical.
Likewise, Garnica (13) mentions cases
where the surgery had to be converted; in
the TILC group, there was a need to place
an extra trocar in a patient with a history
of cholangitis and endoscopic instrumen-
tation of the biliary tract, since among the
intraoperative findings, a partially intrahe-
patic thick-walled gallbladder stood out,
whose mobilization was not feasible using
only the method of fundal retraction with the
trans-parietal needle. In the consulted lite-
rature, it is evident that the conversion ra-
tes for this procedure are 3-5% in difficult
cases, making the clarification that the term
"conversion" in this context is not synony-
mous with open surgery, but rather refers to
the act of placing one or two extra trocars to
facilitate the surgical procedure.
Laparoscopic cholecystectomy, according
to Garnica (13), has revolutionized gallbla-
dder surgery since its introduction in 1985,
becoming the gold standard for the treat-
ment of symptomatic gallstone disease.
This procedure has proven to be superior
to traditional open surgery in terms of aes-
thetic results, less postoperative pain, and
faster recovery, allowing patients to return
to their daily activities in less time. Over the
years, the laparoscopic technique has been
refined and expanded to include a variety
of indications, from cholelithiasis to acu-
te cholecystitis and gallstone pancreatitis.
However, it is crucial to consider contraindi-
cations and carefully evaluate patients with
significant comorbidities, as general anes-
thesia and pneumoperitoneum can increase
risks in certain groups.
For Garnica (13), the success of laparosco-
pic cholecystectomy also depends on the
surgeon's skill and experience, especially
in complicated cases such as acute chole-
cystitis or the presence of adhesions. Preci-
se identification of anatomy and the appli-
cation of safe techniques, such as critical
view of safety, are fundamental to minimize
intraoperative and postoperative complica-
tions. In summary, laparoscopic cholecys-
tectomy has not only improved surgical out-
CHANCUSIG REINOSO, A. S., SOLIS VINUEZA, A., SALGADO CEDEÑO, J. D., & VILLAGÓMEZ ALBÁN, N. F.